Classifying ethnicity utilizing the Canadian mortality data base

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Abstract
The study of ethnic differences in disease is a methodological challenge as ethnicity is often not identified in existing datasets and surrogate measures need to be used. We have developed a novel methodology combining last name and country of birth to study mortality patterns of Canadians of South Asian (SA) and Chinese (CH) ethnic origin and have compared death rates among SA, CH, and White (WH) Canadians. Methods. SA and CH were identified in the Canadian Mortality Data Base (CMDB) using the last name and country of birth of the deceased. Records of people who had been born in countries with large South Asian and Chinese populations (e.g. India, Pakistan, China, Hong Kong) were selected and manually screened by last name. A name directory was then created of distinct South Asian and Chinese names and this directory was used to search all other records in the CMDB for SA and CH deaths. Where necessary, other identifying characteristics such as first name and parents’ last name were also used. Population counts were obtained from the Census self‐reported question on ethnicity for SA and CH. WH were identified as non‐immigrant Canadians who were neither SA nor CH. The method of assigning ethnicity in the CMDB and Census were assessed for comparability and issues of validity and reliability were addressed. Results. Using this method, 10 989 SA and 21 548 CH deaths were identified. There was marked heterogeneity in birthplace, with only 56% of SA born in South Asia and only 74% of CH born in Greater China. Last names had high validity for self‐reported ethnicity in a population sample of SA and were highly reproducible. Mortality rates varied dramatically between groups studied. SA and WH had high rates of ischemic heart disease while stroke mortality was similar among all three groups. Cancer death rates were high in CH and WH and much lower in SA. Conclusion. Last names and country of birth can be used to determined ethnicity of SA and CH with validity and reliability, and leads to a more accurate classification than country of birth alone. The contrasting patterns observed in mortality from major causes of death suggest many interesting hypotheses for further study.